DOCSLIB.ORG

BTS Guidelines Control and Prevention of Tuberculosis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
BTS Guidelines Control and Prevention of Tuberculosis Thorax 2000;55:887–901 887 BTS Guidelines Thorax: first published as 10.1136/thorax.55.11.887 on 1 November 2000. Downloaded from Control and prevention of tuberculosis in the United Kingdom: Code of Practice 2000 *Subcommittee comprising Peter Joint Tuberculosis Committee of the British Thoracic Society* Ormerod, Royal Infirmary Blackburn (Chairman, Joint Tuberculosis Committee); Craig Keywords: tuberculosis; BTS guidelines; code of Skinner, Heartlands Abstract practice Hospital, Birmingham; Background—The guidelines on control John Moore-Gillon, St and prevention of tuberculosis in the Bartholomew’s and The United Kingdom have been reviewed and Introduction/evidence criteria Royal London Hospitals, updated. London; Peter Davies, Since publication of the previous control and Aintree University Methods—A subcommittee was appointed prevention guidelines in 19941 new data have Hospital, Liverpool; by the Joint Tuberculosis Committee become available in a number of areas, Mary Connolly, Chest (JTC) of the British Thoracic Society to particularly in infection control, bovine tuber- Clinic, Birmingham revise the guidelines published in 1994 by culosis, and the risks of transmission of tuber- (representing Royal the JTC, including representatives of the culosis during air travel which have brought College of Nursing Royal College of Nursing, Public Health Tuberculosis Special requests for advice. The epidemiology of Interest Group); Virginia Medicine Environmental Group, and tuberculosis in Britain has continued to change Gleissberg, Chest Clinic, Medical Society for Study of Venereal in recent years. Newham, London Diseases. In preparing the revised guide- The numbers of notified cases in England (representing Royal lines the authors took account of new pub- and Wales, which had declined to 5085 in College of Nursing lished evidence and graded the strength of Tuberculosis Special 1987, rose to 5798 in 1992 and 6087 in 1998. Interest Group); John evidence for their recommendations. The The increases have been greatest in urban Watson, Public Health guidelines have been approved by the JTC areas, particularly in London, whereas the Laboratory Service and the Standards of Care Committee of decline has continued in most rural areas.2 The Communicable Disease the British Thoracic Society. 1998 National Survey of Tuberculosis in Eng- Surveillance Centre, Recommendations—Tuberculosis services land and Wales confirmed a continuation of the http://thorax.bmj.com/ London (representing in each district should have staYng and Faculty of Public Health trend for increasing numbers of cases in Medicine); Anton resources to fulfil both the control and pre- minority ethnic groups such as those of Indian Pozniak, Chelsea and vention recommendations in this docu- subcontinent and black African origin.3 Notifi- Westminster Hospital, ment and to ensure adequate treatment cation rates in these groups remain very high. London (representing monitoring. Notification of tuberculosis is In 1998, 56% of reported cases were in people Medical Society for the required for surveillance and to initiate not born in the United Kingdom. HIV contin- Study of Venereal contact tracing (where appropriate). The Diseases); Ruth Gelletlie, ues to contribute to tuberculosis case numbers: Bradford (representing following areas are discussed and recom- at least 3.0% of tuberculosis cases in 1998 were the Public Health mendations made where appropriate: (1) estimated to be HIV infected. Drug resistance on September 24, 2021 by guest. Protected copyright. Medicine Environmental public health law in relation to tuberculo- remains an important issue although rates have Group); Ann Cockcroft, sis; (2) the organisational requirements for not risen in recent years.4 In 1998, 6.1% of ini- Occupational Medicine tuberculosis services; (3) measures for tial isolates in the United Kingdom were resist- Department, Royal Free control of tuberculosis in hospitals, includ- Hospital, London ant to isoniazid and 1.3% were multidrug (co-opted); Francis ing segregation of patients; (4) the require- resistant (PHLS unpublished data (Mycob- Drobniewski, Director ments for health care worker protection, net)). The Joint Tuberculosis Committee PHLS Mycobacterium including HIV infected health care work- (JTC) of the British Thoracic Society (BTS) Reference Unit, London ers; (5) measures for control of tuberculo- has reviewed these new and previous data to (co-opted); Jane Leese, sis in prisons; (6) protection for other produce this updated advice. No category A Department of Health, groups with potential exposure to tubercu- 56 London. data using recognised criteria (table 1) are losis; (7) awareness of the high rates of available, category B recommendations are Correspondence to: tuberculosis in the homeless together with highlighted throughout the text, and all other Professor L P Ormerod, local plans for detection and action; (8) recommendations should be regarded as of Department of Respiratory detailed advice on contact tracing; (9) con- Medicine, Blackburn Royal category C level. Infirmary, Blackburn tact tracing required for close contacts of BB2 3LR, UK bovine tuberculosis; (10) management of [email protected] tuberculosis in schools; (11) screening of Notification/surveillance All forms of tuberculosis are compulsorily Received 2 April 2000 new immigrants and how this should be Returned to authors performed; (12) outbreak contingency in- notifiable under the Public Health (Control of 20 June 2000 vestigation; and (13) BCG vaccination and Disease) Act 1984. The doctor making or sus- Revised version received pecting the diagnosis is legally responsible for 27 July 2000 the management of positive reactors found Accepted for publication in the schools programme. notification. A decision to commence treat- 22 August 2000 (Thorax 2000;55:887–901) ment (but not chemoprophylaxis) indicates a www.thoraxjnl.com 888 Joint Tuberculosis Committee of the British Thoracic Society Table 1 Levels of evidence and grading of recommendations (based on AHPCR 56) interventions monitored. Since January 1999 a Thorax: first published as 10.1136/thorax.55.11.887 on 1 November 2000. Downloaded from national programme of enhanced surveillance Level Type of evidence has been running in England and Wales and Ia Evidence obtained from meta-analysis of randomised Northern Ireland joined the scheme from controlled trials January 2000. Scotland also began enhanced Ib Evidence obtained from at least one randomised controlled trial tuberculosis surveillance from January 2000. IIa Evidence obtained from at least one well designed In many health districts the form for the controlled study without randomisation enhanced surveillance acts as the notification. IIb Evidence obtained from at least one other type of well designed quasi-experimental study Participating in enhanced surveillance is III Evidence obtained from well designed strongly supported by the JTC as it will allow non-experimental descriptive studies such as continuous monitoring of numbers of cases, comparative studies, correlation studies, and case controlled studies types of disease, and geographical distribution IV Evidence obtained from expert committee reports of and will ultimately form the basis for regular opinions and/or clinical experiences of respected outcome monitoring. It will, however, need to authorities be appropriately resourced. Detailed advice on Grade Type of recommendations notification and improving notification rates is A (levels Ia, Ib) Requires at least one randomised controlled trial as 7 part of a body of literature of overall good quality and available. consistency addressing the specific recommendation B (levels IIa, IIb, III) Requires availability of well conducted clinical studies but no randomised clinical trials on the topic of Public health law recommendation Compulsory treatment is not allowed but in C (level IV) Requires evidence from expert committee reports or opinions and/or clinical experience of respected exceptional circumstances it may be necessary authorities. Indicates absence of directly applicable to consider compulsory admission of a patient studies of good quality who is causing serious risk of infection to others.10 Compulsory admission is only possi- Table 2 Areas to be covered by the local tuberculosis policy ble where the person has infectious tuberculo- sis of the respiratory tract. Clearly this is not v Aims and objectives v Contact tracing the kind of action to be undertaken lightly as it v Surveillance v Immunisation including neonatal policy v Identification of cases v Occupational health involves depriving someone of his or her v Diagnosis v Prisons and other institutions liberty. The CCDC or equivalent and tubercu- v Notification v Education and training losis clinician will want to discuss possible v Treatment v Monitoring and audit v Case management v Health education invocation of the law with the legal department v Outcome monitoring v Provision of adequate resources of their local authority. If the person has to be v Hospital infection control v Research and audit v Screening of vulnerable groups (asylum v Contingency arrangements for outbreak detained it will be necessary to obtain a magis- seekers, refugees, homeless people, etc) investigation trate’s order for admission (Section 37) and another order for detention (Section 38).10 level of suspicion which should trigger notifica- Compulsory medical examination can also be tion for all forms of tuberculosis. required (Section 35) under the Public Health
Load more

Recommended publications
  • Protocol for the Care of Patients with Tuberculosis
    Infection Control Policy 2011; Appendix D, Clinical Care Protocol 26 Protocol for the care of patients with tuberculosis Policy Profile Policy Reference: Clin.2.0 Appendix D Clinical care protocol 26 Version: 3.0 Author: Juliana Kotey, Senior Infection Control Nurse Executive sponsor: Director of Infection Prevention and Control Target audience: All Trust Staff Date issued: 16 October 2012 Review date: September 2015 Consultation Key individuals and Infection Control Committee Dates committees consulted Infectious Diseases Dates May 2012 during drafting Doctor/Matron Health Protection Unit May 2012 Community Services Dates June 2012 Wandsworth DDN/Staff Ratification Ratification Committee: Policy Ratification Group Date: 17 th May 2012 Document History Vers ion Date Review date Reason for change 1 2002 2004 2 2007 2010 3 2012 2015 Reviewed and updated in line with guidance. Page 1 of 11 Infection Control Policy 2011; Appendix D, Clinical Care Protocol 26 Contents Paragraph Page Executive Summary 3 Scope 3 1 Introduction 4 2 Mode of Transmission 4 3 Risk of Transmission 4 3 Non - Respiratory Tract Tuberculosis (Closed TB) 5 4 Respiratory Tract Tuberculosis (Open TB) - Sensitive Strains 5 Respiratory Tract Tuberculosis (Open TB) – Multi Drug 5 Resistant Strains (MDR TB) and Extensively Drug Resistant 6 (XDR TB) 6 Induced Sputum Specimens – sensitive and MDR TB 7 7 Contact Tracing 8 8 Incident Management 8 9 Associated Documents 9 10 References 10 Appendix A Algorithm 1 TB Care Pathway 11 Page 2 of 11 Infection Control Policy 2011; Appendix D, Clinical Care Protocol 26 Executive Summary This document is an evidence-based protocol for the implementation of sound tuberculosis (TB) infection control by all healthcare workers.
    [Show full text]
  • Diagnosis of Tb
    DIAGNOSIS OF TB DR. KONG PO MARN KONG CLINIC FOR CHEST & INTERNAL MEDICINE PATHOGENESIS OF TB INFECTION AND DISEASE (I) PATHOGENESIS OF TB INFECTION AND DISEASE (II) MODES OF DIAGNOSIS • Microbiologic • Smear • Culture • Others ( MODS etc) • Molecular • Nucleic Amplification Assays (NAA) • IFN-γRelease Assays (IGRA) • Line-probe PCR for drug sensitivity testing • Urinary Assays CURRENT PROBLEMS • Active disease • Smears are insensitive • NTM make up 5% of positive smears locally • Cultures take too long ( 12 to 14 days to be positive) • Latent TB Infection (LTBI) • Mantoux test since 1981 • BCG, NTM and boosting can confound issue • Low sensitivity and specificity • Repeat visits NEW MODALITIES IN THE DIAGNOSIS OF ACTIVE TB • NAA • Brochoalveolar lavage with Elispot • Urinary assays ? NUCLEIC AMPLIFICATION TESTS/PCR • Rationale • Isolation issues • Issues with current TB testing • MDR-TB • Standardized and come in kit forms NAA • Amplicor: DNA PCR • Amplified / Enhanced MTD / MTA: rRNA detection • Both FDA approved • In 1999, E-MTD approved for use in both smear positive and negative specimens NAA • Sensitivity is markedly improved cf. smears • MTD: Sensitivity usually range from 83 to 98% in smear + cases. 70 to 81% in smear negative cases. Amplicor slighly less • Specificity is 98 to 99% • Negative predictive value is more important NAA • E-MTD / MTA • Improved sensitivity in smear negative cases • 1999 study. 489 inmates in Texas prison • Overall sensitivity of 95.2% and specificty of 99.1%. • 100% in smear positive cases • 90.2% and 99.1% in smear negative cases • Ontario study (1999) using clinical diagnosis as reference gave nearly 100% specificity and sensitivity for both smear + and sm- cases (Case selection !!) Figure 2.
    [Show full text]
  • The Putrefied Body Niques Require Care but Little Skill to Perform
    1300 BRITISH MEDICAL JOURNAL 19 MAy 1979 hospital staffing. All too often, however, reasonable proposals in the tine test), the repeatability of the results, and their for reform are not put into practice, and the same may happen comparability with those of the Mantoux test. here. Consultants will feel threatened: some will lose junior Ideally we should have a single screening test of tuberculin Br Med J: first published as 10.1136/bmj.1.6174.1300 on 19 May 1979. Downloaded from staffand long term the quality ofconsultant work will change- sensitivity that is simple, reliable, easily read, repeatable, safe, and inevitably there will be a sharpening of the contrasts and cheap. None has proved supreme in practice. The many between teaching and non-teaching hospitals and between comparisons of the Mantoux with the multiple-puncture popular and shortage specialties. Junior staff will not like the techniques have given confficting results. In 1959 a report of restriction on their freedom of choice; and overseas doctors the Research Committee of the British Tuberculosis Associa- will complain that they are being singled out for special tion2 concluded that, for epidemiological use, the Heaf treatment. multiple-puncture test would be preferable to the Mantoux 5 All these groups must surely recognise that changes are TU test because of its greater sensitivity; the Heaf test gave overdue, and if they reject the proposals they have an obliga- results intermediate between 5 TU and 100 TU Mantoux tion to suggest alternatives. If there is too much opposition, tests. In 1964 Emerson3 compared the Heaf and tine tests and however, committees that should be taking unpopular deci- found that more than 15% of tuberculin-positive reactors were sions may not do so.
    [Show full text]
  • Tuberculosis
    Eye (2006) 20, 1068–1073 & 2006 Nature Publishing Group All rights reserved 0950-222X/06 $30.00 www.nature.com/eye 1 1 1 1 CASE SERIES Tuberculosis: an D Varma , S Anand , AR Reddy , A Das , JP Watson1, DC Currie2, I Sutcliffe2 and under-diagnosed OC Backhouse1,2 aetiological agent in uveitis with an effective treatment Abstract around the eye, or on its surface. Classically, ocular TB has been divided into two types: Purpose To highlight the diversity of clinical primary and secondary. Primary disease implies presentations with tubercular uveitis in a that the eye is the initial port of entry while in nonendemic setting, and discuss the secondary disease the organisms spread to the diagnostic approach and an effective eye haematogenously. Primary disease includes treatment. conjunctival, corneal, and scleral disease, while Method Descriptive case series. tuberculous uveitis is a manifestation of Results A total of 12 cases of varied secondary disease. The most common clinical presentations of tubercular uveitis diagnosed findings of intraocular TB include solitary or over a period of 1 year of which six cases are multiple choroidal nodules, choroiditis, and described in detail. Presentations included retinal vasculitis.2–5 The choroidal nodules choroidal tuberculomas, multifocal suggest direct haematogenous infection while choroiditis, recurrent granulomatous uveitis, the vasculitis and choroiditis are more likely to panuveitis with cystoid macular oedema, and be the result of immune hypersensitivity. serpiginous choroiditis. All cases had a Anterior tuberculous uveitis is typically chronic or recurrent course and responded granulomatous and an accompanying vitritis is very well to antitubercular treatment. not uncommon.2 TB should be considered in the Diagnosis was mainly assisted by positive differential diagnosis of chronic anterior tuberculin testing.
    [Show full text]
  • Tuberculin Positive Children Thorax: First Published As 10.1136/Thx.47.10.768 on 1 October 1992
    768 Thorax 1992;47:768-769 Tuberculin positive children Thorax: first published as 10.1136/thx.47.10.768 on 1 October 1992. Downloaded from Children have been routinely tuberculin tested as a screen- which detected 27 of the 45 notifications in the survey. ing procedure during the school BCG vaccination When the first year was excluded those with grade 3 and 4 programme in Britain since 1952. The test is generally Heafreactions had an annual notification rate of 1-61/1000; made with the Heafmultiple puncture apparatus. The fixed the corresponding rate for grade 2 reactors was 0-43. head Heaf gun requires disinfection by immersion in During 1970-83 5380 positive reactors were surveyed.5 alcohol followed by ignition of the spirit before each test to Initial chest radiographs yielded 10 cases, only five more prevent cross infection.' A new disposable head apparatus cases being notified during subsequent follow up.6 The ratio (Bignell 2000) is now available and is the method of choice of new cases detected to initial radiographs taken was 1:555 as it eliminates the risk of crossinfection and is simple and for grade 2 reactors, 1:75 for grade 3, and 1:25 for grade 4. accurate in tus is appve joint We may reasonable conclude from the results of these Committee on Vaccination and Immunisation and an studies that for previously unvaccinated children of white explanatory video has been produced by the Department of ethnic origin who are grade 3 and 4 reactors an initial Health.2 The proportion of schoolchildren aged 1013 examination and chest radiograph is valuable.
    [Show full text]
  • Tuberculin Testing: Its Basis, Methods, and Comparative Results
    Tuberculin testing: Its basis, methods, Tuberculin test and comparative results DOUGLAS P. HAGEN, D.O. Kirksville, Mo. Several procedures for administering test has converted to positive. Several methods tuberculin for skin testing of performing tuberculin skin tests will be re- viewed, and the results of the methods will be are reviewed. The Mantoux test is compared. considered the most accurate, in that the test dose can be measured Basis for tuberculin testing accurately, the equipment and During the first infection with the tubercle materials required are available readily, bacillus, the host acquires hypersensitivity to the organism. Hypersensitivity can be induced and the reactions can be read by the whole tubercle bacillus alone or a and recorded quantitatively. Its chief combination of the wax fraction of the or- disadvantage is the skill required ganism containing a lipopolysaccharide and to administer the test. Multiple-puncture tuberculoprotein but not by tuberculoprotein techniques need minimal skill alone. The reaction that occurs when an anti- for administration and false negative gen to tuberculosis is introduced intradermally provides a valuable testing procedure for both reactions are rare. However, the epidemiologic and case finding purposes. tuberculins are not well standardized, Tuberculin testing material is basically of the dose of tuberculin two types, old tuberculin (OT) and purified retained in the skin is unknown, and protein derivative (PPD). Old tuberculin is false positive reactions may a concentrated filtrate of broth in which tu- occur. Because of the variables affecting bercle bacilli have grown for 6 weeks. Cultures of Mycobacterium tuberculosis are heat-ster- the dose, quantitative measures ilized.
    [Show full text]
  • Comparison of Heaf and Mantoux Tests in the Cali Area of Colombia
    Comparison of Heaf and Mantoux Tests in the Cali Area of Colombia GUILLERMO OROZCO, M.D., and GUY S. HAYES, M.D. DECEMBER 1959, the Arden House Con¬ bia, we carried out a series of Heaf tests on a INference on Tuberculosis emphasized the need random sample of the population that included for a simple and accurate tuberculin test that all ages. The tests were included in the survey could be applied and read by nonprofessional at the suggestion of Dr. Robert M. Lennox, then health personnel (1). This need is greatest in visiting professor of pediatrics at the Univer¬ developing countries where tuberculosis is often sidad del Valle and now professor of child a major public health problem and professional health, Tulane University School of Medicine. health personnel are in short supply. In Co¬ Shortly thereafter, we tested a small group of lombia, although the exact magnitude of the school children in Candelaria with both Heaf tuberculosis problem is still unknown, substan¬ and Mantoux techniques. The results en¬ tial evidence indicates that the disease is a ma¬ couraged us to carry out a more extensive field jor cause of disability and death. trial of the two methods in 1962 and 1963. The In 1951, Dr. Frederick Heaf (2) published primary objective of this study was to compare his technique for a multiple-puncture tuberculin Heaf and Mantoux tests in individual subjects. test that seemed to have several advantages over For our purposes, diagnostic implications of the the routine Mantoux procedure: not only did it test results were a side issue.
    [Show full text]
  • Contact Investigation for Tuberculosis: a Systematic Review and Meta-Analysis
    Eur Respir J 2013; 41: 140–156 DOI: 10.1183/09031936.00070812 CopyrightßERS 2013 ERJ Open articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 3.0 Contact investigation for tuberculosis: a systematic review and meta-analysis Gregory J. Fox*, Simone E. Barry#, Warwick J. Britton#," and Guy B. Marks*,+ ABSTRACT: Investigation of contacts of patients with tuberculosis (TB) is a priority for TB control AFFILIATIONS in high-income countries, and is increasingly being considered in resource-limited settings. This *Woolcock Institute of Medical Research, University of Sydney, review was commissioned for a World Health Organization Expert Panel to develop global contact #Centenary Institute of Cancer investigation guidelines. Medicine and Cell Biology, University We performed a systematic review and meta-analysis of all studies reporting the prevalence of of Sydney, " TB and latent TB infection, and the annual incidence of TB among contacts of patients with TB. Discipline of Medicine, Sydney Medical School, University of After screening 9,555 titles, we included 203 published studies. In 95 studies from low- and Sydney, and middle-income settings, the prevalence of active TB in all contacts was 3.1% (95% CI 2.2–4.4%, +Dept of Respiratory Medicine, I2599.4%), microbiologically proven TB was 1.2% (95% CI 0.9–1.8%, I2595.9%), and latent TB Liverpool Hospital, Sydney, Australia. infection was 51.5% (95% CI 47.1–55.8%, I2598.9%). The prevalence of TB among household 2 CORRESPONDENCE contacts was 3.1% (95% CI 2.1–4.5%, I 598.8%) and among contacts of patients with multidrug- G.J.
    [Show full text]
  • BCG Efficacy in Children Aged 1-7 Years in a Rural Area in East Nile Province
    University of Khartoum Faculty of Medicine Medical & Health Studies Board BCG Efficacy in Children Aged 1-7 years In A rural Area in East Nile Province By Dr. Mai Mohamed El Hassan Mustafa M.B.B.S (University of Khartoum) A thesis submitted in partial fulfillment for the requirements of the Degree of Clinical MD in Paediatrics and Child Health, February – 2004 Supervisor Dr. Salah Ahmed Ibrahim Associate Professor, Department of Paediatrics and Child Health Faculty of Medicine, U of K 1 TToo …… MMyy lloovveellyy ppaarreennttss …… MMyy hhuussbbaanndd …… MMyy ssiisstteerrss,, bbrrootthheerrss && TToo aallll wwhhoo lloovvee && ttaakkee ccaarree ooff cchhiillddrreenn …… MMaaii 2 ﻗﺎل ﺗﻌﺎﻟﻰ: ﺻﺪق اﷲ اﻟﻌﻈﻴﻢ ﺳﻮرة اﻟﺮﺣﻤﻦ ﺁﻳﺔ رﻗﻢ (4-1) 3 CONTENTS Page - Acknowledgement i - Abstract (English) ii - Abstract (Arabic) iv - Abbreviations vi - List of tables vii - List of figures ix CHAPTER ONE 1. INTRODUCTION & LITERATURE REVIEW 1 1.1. History of tuberculosis 3 1.2. Tuberculosis in Sudan 6 1.3. Aetiology 12 1.4. Epidemiology 13 1.5. Pathology 18 1.6. Clinical Manifestations 19 1.7. Laboratory Diagnosis 39 1.8. Tuberculin skin test 44 1.9. Treatment 55 1.10. BCG vaccine 58 JUSTIFICATIONS 80 OBJECTIVES 81 CHAPTER TWO 2. PATIENTS AND METHODS 82 2.1. Nature of the study 82 2.2. Study area 82 2.3. Duration of the study 83 2.4. Study population 83 2.5. Inclusion criteria 84 2.6. Exclusion criteria 84 2.7. Research methodology 84 2.8. Research team 85 4 2.9. Input of the author 85 2.10. Research tools 86 2.11. Diagnosis 88 2.12.
    [Show full text]
  • Current Status and Unusual Mechanism of Multi-Resistance In
    & Me lth dic ea al I H n f f o o l r m Journal of a n a r Chakraborty, J Health Med Informat 2019, 10:1 t i u c o s J Health & Medical Informatics ISSN: 2157-7420 Research Article Open Access Current Status and Unusual Mechanism of Multi-resistance in Mycobacterium tuberculosis Asit Kumar Chakraborty* Department of Biotechnology and Biochemistry, Genetic Engineering Laboratory, Oriental Institute of Science and Technology, Vidyasagar University, India Abstract TB is a deadly disease and MDR-TB is spreading even DOTS drug regime has rigorously maintained with at least ten new drugs like isoniazid, capreomycin, dapsone, linezolid, pyrazinamide, ethambutol and bedaquiline apart from traditional drugs like rifampicin, streptomycin, amikacin and clarithromycin. Rifampicin inhibits RNA polymerase and mutations in rpo gene codons give resistance. Streptomycin inhibits protein synthesis and mutation of ribosomal proteins and rRNA genes give resistance but no strAB or mphA1-9 mdr genes reported in Mycobacterium. Bedaquiline kills M. tuberculosis by inhibition of the membrane-bound F1F0-ATP synthase complex. Ciprofloxacin and ofloxacin were replaced by moxifloxacin that binds to DNA gyrase inhibiting DNA replication and/or transcription and mutations of gyrA at position 90 and 94 and gyrB at position 74, 88 and 91 give resistance. Kanamycin and amikacin inhibit protein synthesis and mutation of rrs gene gives resistance. However, aac2’-Ic type acetylating enzymes have also been suggested for multi-resistance. Ethambutol interferes with the biosynthesis of arabinogalactan in the cell wall and embB gene mutation at position 306 gives resistance. ErmMT methyl transferase adds methyl group to 23S rRNA at A2058 giving resistance to azithromycin and clarithromycin where capreomycin or viomycin peptide antibiotics may be effective drug.
    [Show full text]
  • Eponyms in Tuberculosis Nora Mohammed Al-Aboud
    2XU'HUPDWRORJ\2QOLQH Historical Article Eponyms in Tuberculosis Nora Mohammed Al-Aboud College of Applied Sciences, Umm Al-Qura University, Makkah, Saudi-Arabia Corresponding author: Dr. Nora Mohammed Al-Aboud, E-mail: [email protected] Tuberculosis (TB) is an old disease and the most There are several eponyms related to TB. Some common cause of infection-related death worldwide. of these eponyms are rarely used in the present In 1993, the World Health Organization (WHO) time. For example some medical dictionaries declared TB to be a global public health emergency. mention about “Lorenz sign”, which is an Table 1: Selected eponyms in tuberculosis Selected eponyms in tuberculosis Remarks Erythema induratum of Bazin [2] In 1861, Bazin gave the name erythema induratum to a nodular eruption that occurred on the lower legs of young women with tuberculosis. Erythema induratum/nodular vasculitis complex is classified into 2 variants: erythema induratum of Bazin type and nodular vasculitis or erythema induratum of Whitfield type. The Bazin type is related with tuberculous origin, but Whitfield type is not. Ernest Bazin (1894-1964), (Fig. 2), was a French physician Ghon’s complex [3,4] It is the initial site of parenchymal involvement at the time of the first infection. It consists of a calcified focus of infection and an associated lymph node. These lesions are particularly common in children and can retain viable bacteria, so are sources of long‑term infection and may be involved in reactivation of the disease in later life Anton Ghon (1866‑1936), was an Austrian pathologist Heaf test [5] It is a diagnostic skin test, was long performed to determine whether or not children had been exposed to tuberculosis infection.
    [Show full text]
  • Evaluation of Rapid Slide Culture Technique for The
    id2067281 pdfMachine by Broadgun Software - a great PDF writer! - a great PDF creator! - http://www.pdfmachine.com http://www.broadgun.com EVALUATION OF RAPID SLIDE CULTURE TECHNIQUE FOR THE DIAGNOSIS OF PULMONARY TUBERCULOSIS. DR. SHAFIKUL ISLAM KHAN M.B.B.S Department of Microbiology Mymensingh Medical College Mymensingh, Bangladesh July 2009 ACKNOWLEDGEMENT First of all thanks to Almighty Allah, the most merciful and the beneficent for giving me the opportunity and providing me enough energy and courage to carry out and complete the entire thesis work. I would like to express my deepest regards and gratitude to my honorable teacher and guide Professor Dr. Md. Akram Hossain, Head of the Department of Microbiology, Mymensingh Medical College, Mymensingh. I shall remain evergrateful to him for his continuous and untiring guidance, active co-operation, valuable suggestions, constructive criticism and constant inspiring to carrying out the work successfully. I would like to express my regards and gratitude to my honorable teacher Professor Abdullah Akhtar Ahmed, Ex-Principal and Head of the Department of Microbiology, Mymensingh Medical College, Mymensingh, for his inspiration. I am grateful and express thanks to the honorable members of the Ethical Review Committee for giving kind approval to my research protocol. I am obliged to Professor Md. Monwar Hossain Principal of Mymensingh Medical College, Mymensingh for his kind permission to conduct the thesis. I would like to express my deepest regards and gratitude to my respected teacher Dr. A. K.M Musa, Associate Professor, Department of Microbiology, Mymensingh Medical College, Mymensingh for valuable advice and cordial co-operation. I owe my gratitude to respected teacher Dr.
    [Show full text]